title: GH secretion reserve in subclinical hypercortisolism.
abstract: OBJECTIVE
  In overt hypercortisolism, growth hormone (GH) secretion is decreased and normalizes after surgery. In subclinical hypercortisolism (SH), GH secretion has been scarcely investigated. We assessed GH reserve in patients with and without SH and, in the former, also after recovery.
  
  
  METHODS
  We enrolled 24 patients with adrenal adenomas, 12 with SH (SH+, 8 females, 58.3 ± 6.5 years) and 12 without SH (SH-; 11 females, 61.8 ± 10.6 years). SH was diagnosed in the presence of ≥ 2 out of: 1 mg overnight dexamethasone suppression test >83 nmol/L, urinary free cortisol (UFC) >193 nmol/day and ACTH levels <2.2 pmol/L. GH secretion was assessed by GHRH + Arginine test (GHRH-ARG) and age-adjusted serum IGF-I levels, expressed as SDS (IGF-I SDS). Eight SH+ patients were re-evaluated after the recovery from SH.
  
  
  RESULTS
  Age, gender, body mass index (BMI) and IGF-I SDS were comparable between SH+ and SH- patients. After GHRH-ARG the mean GH peak levels (GH-P) and GH response (as Area Under Curve, GH-AUC) were lower in SH+ than in SH- patients (15.2 ± 8.1 vs 44.5 ± 30.9 μg/L, P = 0.004 and 1,418 ± 803 vs 4,028 ± 2,476 μg/L/120 min, P = 0.002, respectively), after adjusting for age and BMI. The GH-AUC and GH-P levels were negatively associated with UFC after adjusting for age and BMI (β = -0.39, P = 0.02 and β = -0.4, P = 0.020 respectively). After recovery, GH-P levels and GH-AUC increased as compared to baseline (23.7 ± 16.3 vs 15.8 ± 10.2 μg/L, P = 0.036 and 2,549 ± 1,982 vs 1,618 ± 911 μg/L/120 min, P = 0.012, respectively).
  
  
  CONCLUSIONS
  GH secretion reserve is decreased in SH patients and increases after the recovery.
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, serena.palmieri@hotmail.it.
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Antonio Stefano
authors.initials: AS
authors.lastname: Salcuni
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Elisa
authors.initials: E
authors.lastname: Cairoli
authors.forename: Volha V
authors.initials: VV
authors.lastname: Zhukouskaya
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000378:metabolism* / Q000601:surgery*; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D015992:Body Mass Index; D003480:Cushing Syndrome / Q000097:blood / Q000378:metabolism* / Q000601:surgery; D005260:Female; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone